Fairness neglecting consequences in healthcare

In previous post about fairness we discussed the direct and indirect impact of fairness implementation on the whole healthcare provision and how the proper implementation of its parameters would create society affordability from households in case of expenditure contributions and also exaggerate the effectiveness of fairness reimbursement that would overcome any future financial distress from the fairness perspectives and associated WHO parameters. In this post we would like to discuss the results of implementation and also lack of fairness hypothesis on the provision of medical services. Before we mentioned that fairness provides fair household contributions and medical reimbursement for health workers and stakeholders in order to get at point of self-sufficiency for whole business cycle of the system and moreover with good liquidity management. It supposed to be also back up account for emergency and the other for sudden epidemiological figures might be happen in future. No one can deny that Fairness among healthcare system explained many of former unfavourable results were not understandable before from the researchers and academic policy designers. Complications and signs of neglecting to fairness parameters actually not popular and hard for ordinary medical workers to identify and define lack of fairness within and complications as long as was not there a sort of training to deal with them. However to be more precise here; there are some of back door signs clear enough to be noticed, as a private point of view would like to start with signs and manifestation of system with poor fairness parameters implementation.

First; gap of medical services are considered primitive banner of lack of fairness in that system. Second; absence of successive system progression and growth of mutual revenue ratios with fixed improvement between expenditures and funding even if that funding normal ordinary out pocket payments. Third; health insurance uncovered citizens is a big percent in comparison of total population and that number continuously in growing as a result of those who opted out of system due to lack of financial affordability.  The last one is the easiest one; massive inflation of healthcare costs and provision, this parameter not only defined the gapes of system services distributions but also considered one of the biggest alarm toward hidden financial activities produce additional unaffordable costs and prices.

Now we are crossing the road to get to the opposite side of the post to talk about the complications whether in short or long term. We are know that fairness produced as a result of financial households affordability then what is next?!; the next poor or may be lack of financial access of medical services and therefore; would be over there signs of services inequality and overall health provision inequality. Thus; the community individuals who could not afford to pay their service costs and insurance shares going to be out and insurance market and contributions will be depressed because of poor household contributions of the society.

For sure after all; the chart of population health will become downward or in other word would be kept only for emergency and chronic cases. The medical provider as a result of revenues scarcity of community will apply business game tactics to overcome that liquidity shortage and deviation of income and wholes of income which should be awaited. So, system will offer unnecessary services and load additional cash flow from the patients and the prices will be two or three folds in couple of years in order to increase the revenue longitudinally from the same community number than attract new contributors through decent affordable service costs. I guess now the picture and whole process clear in mind and now the reader easily identify where the point of setbacks of any system you are going to deal with. Full health J

Fairness acclimatization suited to modern system modification

As we mentioned before that fairness is sophisticated academic term used for highly standards research and academic purposes in order to analyze certain segment of society and defined exactly the proper needs and demands of that segment depending on academic analysis hypotheses. But still not all healthcare system actually suitable to use this term and apply WHO parameters for measurements and that actually clearly explain why many countries suffered from gaps in healthcare fairness of contributions and reimbursement. Although from existence of normal medical care expenditures and moreover; in many of those countries with recent inflation and local currency purposely devaluation, found that government healthcare expenditures annually exceed logical norms. However; there are many indications referred by experiences to get noticed even with some of them over strictly implementation of fairness toward the end values.  It preferable to mention here that degree of household affordability with fairness parameter considered the key for assured implementation success. For instance; if we are talking from the perspective of households that should be ready to adapt their expenses and paying capacity to match the growing needs of care payments. The affordability differs even in the same society sector; it means high liquid income with inferior capacity would lead to ineffective current of expenditures whilst moderate income with intensified continuous expenditures will lead to and by practice to proper fairness contributions even on the benchmark of execution schedule. In order to be honest with you here that the point of affordability is more deep to discuss in one post and along years could not imposed and work with all society sectors with the same degree of responsiveness. Indeed, governments still face the same burden to acclimatize the level of affordability in order to reach the same benchmark or at least beginning of the standards for fairness parameters implementations.

If you could not solve the procedures of fairness parameters identification and other associated work concepts to fit in poor management to the point of affordability. Thence proper positive implementation of fairness parameters will not smoothly on the optimum. Evaluation of health expenditures of non-taxed government revenues with level of household subsistence revenues became more fit and work better to achieve equilibrium between care expenditures and future revenues.  Depending on the availability of various formal and informal mechanisms to borrow and save, households may behave as if they average their income over longer periods. In the extreme, the life cycle consumption hypothesis argues that households smooth consumption over the stream of all future income. (Ando A & Modigliani F 1963). As you see the point of synchronization and adjustment between income and expenditures carried long ago high significance to reach point of affordability and then would be more available to implement fairness parameters afterward.

Higher income will never solve the problem unless there is real monetary system depending on the actual values of the household purchases. From previous experiments along working healthcare system easily found high expensive health budget but among inflation mess there are millions could not afford and get fair values from the system and at the end the system going to be crashed as a result of poor funding management and continuous distress liquidity reasons plus sadly existence of humble medical care services and facilities.  Recently; there is a new trend to overcome all these burdens which prevent from attainment society affordability degree to get over first threshold of fairness hypothesis. we want here to remind that affordability is not only welfare to the community members than strong tool to keep the society in self-sufficiency level what going to save future prosperity to the next generations. Full health J

Fairness measurement in healthcare systems

In order to measure the fairness in healthcare and other fairness finance contributions; there are some indicators preferable to know about before. Some of them are not directly related to our medical work but still touching the process of whole financing arena. Healthcare finance contributions and reimbursements undergo many mathematical equations, it means there are many equations involved to identify the real beneficiaries among all medical stakeholders and also to identify the share size and demanded capacity in operation field. More or less there is some sort of complicated calculations and hope our generous reader do not get panic from that, promising to do my best to get them in more simplified form. Operational contribution of fairness in medical care defined as a equal distribution of shares of capacity to pay across households, why particularly households?!. Because most important category and above chart of medical care beneficiaries are the households. Moreover; the whole operational indicators went in the end result in the lap of society members. The ability of society households to pay their share of contributions of medical care values defined probably as effective income minus subsistence expenditures divided on per capita effective income. Therefore, financial contributions (HFC) uncover the variance among sector of community and properly identify medical service deprivations. From the same prospect there are many contribution model charts described considerable variations in the impact of taxes consequences devoted for society medical health. The contributions of disposable income of the households varies from total 50 % of disposable income divided for 25 % for each till the 200% divided for 100% for each. By the way; disposable income the calculated income of households after all paid taxed and in many countries used as gauge of economic overall situation. In order to measure the health financial contributions of certain society segment explained in coming equation:

Where HFCi is the health system financing contribution of the household i, HEi is defined as per capita expenditures of health of household i, and ENSYi is the per capita effective income minus subsistence expenditure of household i. HFC is ideally defined over a period of one year for a households chosen segment of study. But there is a question may be arrived at some readers mind there is no optimum form of contributions among households reach to the proper fairness of healthcare share contributions?!. Actually there is ideal form can serve and achieve better and more utilized financial fairness model among most of medical providers and even devoted to the government accountability toward public sector. World health organization researches did the best to reach such optimum point of assumption and proved its soundness among countries graced this hypothesis. This hypothesis from WHO perceptive described the society segments according to disposable income and power to share and pay your contributions; everyone pays the same amount, everyone pays for what they receive, everyone pay the equal share of their incomes and I have ability to say here fixed share of their income because in some society lack of liquidity will be big burden to achieve the third parameters. Forth parameter; everyone pays the equal share of their disposable income and the difference between two terms mentioned formerly and last one; the richest segment of society pay ten percent for everyone. The parameters are not fixed and there are many of charts and acceptance variations among them but at least we put our hands on guided parameters to modify them for what suited to our life. Full health J

     

Fairness impact on healthcare delivery channels

Fairness as a intrinsic value of financial contribution in healthcare systems which play different role more than just financial term. Fairness Conceptual meaning make it capable of interpretation in compliance with working system procedures and much close to the real monetary environment than theoretical translation. It means more flexibility and more adaptable to whole current reimbursement model of payment. Moreover; it works on valuable integration synergism between taxes, social insurance, private insurance and eventually serve and stand a bit near from the side of out of pocket payers who get the maximum share of services. With proper adjustment between other stakeholders of healthcare provision could possibly be adjusted the result to match different needs beneath the same umbrella of fairness contributions. Subsequently the accessibility into healthcare would be better especially in rural areas and if the access platform available in acceptable standards as a result value end receivers got more satisfied. The improvement and prosperity of the nation would be also upward on chart of integration and higher score in civil life welfare indicators.

Inclusion of fairness in our study terminology and how properly modified in new working suit to fit the modern and modified services. In order to understand the notions of fairness in healthcare systems and the associated involved roles, would be better to get and know what is Unfair if we want to know what is fair?!. The main three concepts of unfairness in healthcare; consist of a) unfair household payments b) unfair work expenditures c) unfair revenues distributions. There are many other branched core definitions and explanations reviewed what it is unfair from different point of views but at the end all actually around these concept of work whether more or less. The unequal payments among households leading to massive degree of unfair behaviour from the medical providers and that unfortunately widely distributed particularly with less educated or cultured communities. The point here is not related to the sort of education you hold than your knowledge about how medical business cycle and what pharmaceutical companies always do to exaggerate the cost of households remedies.

Expenditures inside the operation unites whether diagnostic, clinical and surgical; all kind of medical working unites own some level of expenditure wastes even if that was not been noticed. It mentioned before that there are two main core of any economy; one depending on the future investments and other depending on the expenditures in closed revenue currents in form of taxes and national aids and long term loans with limited source of renewing revenues. Subsequently; who could control properly the process of expenditures, easy to find excess in liquidity favourably work on future development and prosperity. For instance; how many rented medical diagnostic devices versus owned ones, and how many medical providers and level of access availability in front of needed and demanded power of work (capacity)…….etc. There are other examples explained the wide gaps between finance distributions and actually services in need that may support the medical care in from of awareness programs and self disciplined systems implemented through health promotion campaigns and as known their roles ever touch healthcare systems always avoid the entrance to system work components  in details.

Distributions of medical care revenues always form a big gate of accounting manipulation in many countries. For many of them; appearance of minus and depletion of the annual working budget form is a personal victory to increase the budget and to ask more tools and equipments even it is not necessary just to be updated and matching hi-tech era of healthcare for drawn game of appearance. As a truth for all; the most successful healthcare system, that covers all financial obligations and Form additional favourable surge of revenues successively moved up to overcome service demands and modified acclimatization value of services and end used. Full health J

Fairness in healthcare

As we described before concepts of equality and equity among healthcare delivery channels and how it carries direct and future indirect impact forms on quality of service delivery. Today; we review fairness of financial distribution and how far that really significant adapting the delivery to overcome most of system errors and setbacks. Fairness in financial distribution is necessary to most of medical operating unites and it is not exaggerating if we could say that fairness is necessary for sound working channels of medical services especially within scarce revenue producing unites. in order to do better financial distributions in the same frame of work hierarchy labour force and of course lack of low grades of financial assumption, that need much more transparency and will to do properly professional distributions. Moreover; reveal the available resources with lowest possible of bias and favourable progressive decrease in expenditures. This problem it may be written in some few words and actually it takes years to acclimatize the healthcare delivery channels and other aside working pathways with necessary supportive stakeholders.

It get my idea as it is exactly inside my head; would be preferable to get full imagination about fairness among financial channels and revenue currents produced by healthcare whole process and received values. Here it is not intended only labour force expenditures and associated adhered expenses although that is biggest part would distinguish tracked bias but also working on enhancement the efficiency and competence of system involved unites and tools required for processing and implementations. Proper distributions of financial burden could fit more the continuous progressive demands of services and value receivers surge. Therefore; back yard actions from maintenance and regular checking up of service delivery current push indirectly to reorganize the resources in good way serve the further development and needed competency outright.

Fairness is considered complicated concept of financial term particularly in healthcare and for that reason was difficult to find on view description talk about. In the time there are organizations suffered because of financial contributions and distributions bias with poor money management made the final results miserable. In 2000 world health organization put one of the nearest definitions to benchmark of financial term touched closely the contribution and money management as follow:

Our definition, measure and index of fairness in financial contribution are designed and developed to be applicable across and within countries with varying types of health systems and at different stages of development and of the health transition. The index can be used as a tool to analyse changes over time within countries such as the results of health reform, economic crises, or policies such as decentralisation. Some empirical applications considering differences across countries and relating these to the organisation of health systems are discussed in companion publications.(World

Health Organization 2000;Xu et al. 2000).

In coming posts we are going deeply in fairness measurement process and how could be measured and with some equations serve that purpose. We repeat here that fairness in health care is more related to use healthcare policies and adaptable tool of measurement to the financial resources and make them balanced to produce and favourably utilized future revenues and contributions in a way attains self sufficiency by time with minimization to the total debit chart of the system through professional analysis of distributions. If devoid of; many biases are going to be existed whereas at the end, the whole system got hard to run smoothly under the umbrella of massive burden of financial distresses and growing obligations. Full health J